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Mead Over is a senior fellow at the Center for Global Development researching economics of efficient, effective, and cost-effective health interventions in developing countries. Much of his work since 1987, first at the World Bank and now at the CGD, is on the economics of the AIDS epidemic. After work on the economic impact of the AIDS epidemic and on cost-effective interventions, he co-authored the Bank’s first comprehensive treatment of the economics of AIDS in the book, Confronting AIDS: Public Priorities for a Global Epidemic(1997,1999). His most recent book is Achieving an AIDS Transition: Preventing Infections to Sustain Treatment (2011)in which he offers options, for donors, recipients, activists and other participants in the fight against HIV, to reverse the trend in the epidemic through better prevention. His previous publications include The Economics of Effective AIDS Treatment: Evaluating Policy Options for Thailand (2006). Other papers examine the economics of preventing and of treating malaria. In addition to ongoing work on the determinants of adherence to AIDS treatment in poor countries, he is working on optimal pricing of health care services at the periphery, on the measurement and explanation of the efficiency of health service delivery in poor countries and on optimal interventions to control a global influenza pandemic.

In addition to his numerous research projects at the Center, Over currently serves as a member of PEPFAR’s Scientific Advisory Board and as a member of the Steering Committee of the HIV/AIDS modeling consortium funded by the Bill & Melinda Gates Foundation.

Recruited to the World Bank as a Health Economist in 1986, Mead Over advanced to the position of Lead Health Economist in the Development Research Group, before leaving the World Bank to join the Center for Global Development in 2006. Each spring since 2005, he has taught a module on “Modeling the Cost-Effectiveness of Interventions against Infectious Diseases” as part of the master’s degree program in health economics for developing countries at the Centre d'Etudes et de Recherches sur le Développement International (CERDI) at the University of the Auvergne, Clermont-Ferrand, France.

"Evaluating the Impact of Organizational Reforms in Hospitals," with Naoko Watanabe, Chapter 3 in A. Preker and A.Harding (eds.) Innovations in health service delivery: The corporatization of public hospitals. World Bank, March 2003

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More From Mead Over

We here at CGD tend to be critical of international agencies like WHO or the UNDP for establishing targets or guidelines without sufficient consideration of the impacts, for good and ill, of those guidelines in the affected countries. Such guidelines often apply standards more appropriate to rich countries and then pressure poor countries to behave as if they were rich.

The 2014-2015 Ebola outbreak in West Africa was a disturbing demonstration of the inadequacy of international institutions to assist the affected peoples or learn how to better treat and prevent their illness. Experts on a CGD panel discussed their experiences working on crisis response during the Ebola outbreak—and how we can do better.

The 2014-2015 Ebola epidemic broke out and affected thousands of people at a time when there were no medicines approved to treat or prevent Ebola. Poor infrastructure, capacity gaps, widespread mistrust, and disagreements over the design and ethical nature of any clinical trials complicated efforts to conduct research on investigational drugs and vaccines. In the wake of the outbreak, the National Academies of Sciences, Engineering, and Medicine tasked a committee with analyzing the clinical trials carried out during the outbreak and developing recommendations to improve the implementation of such trials in the future. In this session, committee members Gerald Keusch and David Peters will discuss findings from the committee’s recently released report and the kind of governance structures that need to be in place for effective international coordination and collaboration.

At our recent event, “How Can Finance Ministries Support a Sustainable HIV Response?” representatives from PEPFAR and the US Department of Treasury came together to discuss an innovative partnership between them and with finance ministries around the world. The partnership aims to improve the coordination and productivity of resources devoted to combatting HIV/AIDS in low- and middle-income countries, and to strengthen the long-term feasibility of these efforts.

Without PEPFAR, it’s safe to say that almost all of Africa would be stuck near zero HIV treatment coverage. Instead, 49 percent of HIV-infected people were receiving life-saving treatment in 2014, rising to 56 percent by 2015, and the top-performing countries are still gaining ground. This dramatic increase in treatment coverage is a prodigious achievement—and the United States deserves most of the credit. But despite these accomplishments, much more work is needed to reach the end of the epidemic.

On September 23, the Washington Post aired a disagreement between the US Center for Disease Control Ebola experts and the Médecins Sans Frontieres Ebola doctors regarding the value of community Ebola treatment centers staffed with community volunteers for Liberia, Guinea, and Sierra Leone.

As the Ebola epidemic continued to spread in West Africa, with more than 3,000 cases and 1,500 deaths, I invited CGD senior fellow Mead Over, a health economist and one of the world’s top experts on the economics of HIV/AIDS, to discuss newly released maps from the World Health Organization (WHO) and measures for limiting the economic fallout from the epidemic.

The World Bank is reorganizing. Bloomberg reports that president Jim Yong Kim has written staff about a shake-up at the bank’s highest levels in preparation for implementing an as-yet-to-be-announced new institutional strategy. Such can be unsettling for bank employees, some of whom will find their jobs on the line and others who may get new bosses. Is there any reason for the rest of the world to care?

U.S. global AIDS spending is helping to prolong the lives of more than a million people, yet this success contains the seeds of a future crisis. Escalating treatment costs coupled with neglected prevention measures mean that AIDS spending is growing so rapidly that it threatens to squeeze out U.S. spending on other global health needs, even to the point of consuming half of the entire U.S. foreign assistance budget by 2016. Mead Over argues that AIDS treatment spending could quickly become a global entitlement since withdrawing funding for life-saving drugs would mean death for the beneficiaries. He offers suggestions for avoiding a ballooning AIDS treatment entitlement, including greatly stepped-up prevention efforts.

This report offers a strategy for the Global Fund to get more health for the money by focusing more on results, maximizing cost-effectiveness, and systematically measuring performance throughout its operations.

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This paper uses contract theory to suggest simple contract designs that could be used by the Global Fund. Using a basic model of procurement, we lay out five alternative options and consider when each is likely to be most appropriate. We ultimately provide a synthesis to guide policy makers as to when and how 'results-based' incentive contracts can be used in practice.

Controlling healthcare costs while promoting maximum health impact in the recipient countries is one the biggest challenges for global health donors. This paper views global health donors as the regulators of monopolistic service providers, and explores potential optimal fund payment systems under asymmetric information. It provides a summary and assessment of optimal price regulation designs for monopolistic service providers.

The South African government is currently discussing various alternative approaches to the further expansion of antiretroviral treatment (ART) in public-sector facilities. Alternatives under consideration include the criteria under which a patient would be eligible for free care, the level of coverage with testing and care, how much of the care will be delivered in small facilities located closer to the patients, and how to assure linkage to care and subsequent adherence by ART patients.

In this paper, the authors set out to study how increased access to antiretroviral therapy affects sexual behavior in Mozambique. The researchers found that greater access to antiretroviral therapy led Mozambicans to perceive HIV/AIDS as less dangerous and to engage in more risky sexual behavior. The authors conclude that prevention programs must include educational messages about antiretroviral therapy in order to temper changing beliefs about HIV.

Using panel data from Mozambique collected in 2007 and 2008, the authors explore the impact of the food crisis on the welfare of households living with HIV/AIDS. While HIV households have not suffered more from the crisis than others, infected people who experienced a negative income shock also expereinced a reduction or a slower progression in outcomes when treating their illness.

Senior fellow Mead Over estimates the effect of AIDS on poverty in South Asia and analyzes public policy options to help the region’s predominantly private health care systems meet the challenge of treating AIDS. He finds that South Asian governments should play a larger role in AIDS treatment than in other aspects of health care, in the interest of both efficiency and equity.

U.S. global AIDS spending is helping to prolong the lives of more than a million people, yet this success contains the seeds of a future crisis. Escalating treatment costs coupled with neglected prevention measures mean that AIDS spending is growing so rapidly that it threatens to squeeze out U.S. spending on other global health needs, even to the point of consuming half of the entire U.S. foreign assistance budget by 2016. Mead Over argues that AIDS treatment spending could quickly become a global entitlement since withdrawing funding for life-saving drugs would mean death for the beneficiaries. He offers suggestions for avoiding a ballooning AIDS treatment entitlement, including greatly stepped-up prevention efforts.